Post-Traumatic Stress Disorder in Family Members of SBS Victims
Kevin J. Becker, Psy.D., Director, The Trauma Center, Brookliner, MA
Post-Traumatic Stress Disorder (PTSD), is one possible response for family members of victims of shaken baby syndrome (SBS). Although many people are aware of PTSD as a disorder which develops in Vietnam veterans or rape survivors, the symptomatology that makes up the diagnosis can be caused by virtually any life threatening event. In the case of SBS, the family members and loved ones of the shaken child may develop PTSD even though they were not the direct victim of the assault.
Although literary references to post-traumatic symptoms are found as early as the 1600s, the first clinical description was made in 1871 by Jacob DeCosta, MD. DeCosta noted that returning Civil war soldiers suffered from heart palpitations, anxiety and depressive symptoms he called 'Irritable Heart Syndrome'. Over the course of the past century numerous terms have been used to describe post-traumatic symptomatology. 'Shell shock', 'battered-woman syndrome' and 'Vietnam vet syndrome' have all been used to describe the diagnosis we now know as PTSD.
The research and treatment of psychological trauma has greatly expanded in the last 20 years. In 1980 the American Psychiatric Association first acknowledged PTSD as a discernible condition in its Diagnostic and Statistical Manual, 3rd Edition. One of the unique aspects of the PTSD diagnosis is that it can only be made if the symptoms have resulted in response to the person experiencing a life threatening event to themselves or someone else. Other mental disorders continue to be diagnosed solely on the presence of a set of symptoms, with no regard to why those symptoms exist. PTSD and a more recently described condition, Acute Stress Disorder represent a major paradigm shift which has allowed clinicians and trauma survivors to understand post-traumatic symptoms as a 'normal response to an abnormal event'. This is extremely significant because it removes the victim blaming so often inherent in the diagnosis of mental illness. Simply put, a person develops PTSD because they have experienced something extremely frightening which left them with a sense of intense fear, horror or helplessness.
Post-traumatic symptoms fall into three categories; reexperiencing, avoidance and hyperarousal. Reexperiencing symptoms include nightmares, intrusive images and flashbacks. Typical avoidance symptoms include efforts to avoid recollections of the trauma, a foreshortened sense of future and feelings of detachment from others. Difficulty falling or staying asleep, irritability and exaggerated startle response are some of the more common hyperarousal symptoms. Acute Stress Disorder encompasses the same symptoms as PTSD but they resolve in under 4 weeks.
For parents and other surviving SBS family members, the development of post-traumatic symptoms and PTSD is a serious risk. In the general population, approximately 30% of individuals exposed to life-threatening events will develop PTSD. In a recent study by Murphy et al (1999), parents of murdered children aged 12-28 years old developed PTSD at twice the rate of parents whose children died by accident or suicide. Although the study did not examine infant deaths, there are very likely implications for understanding PTSD in the parents of children killed by SBS.
Overpeck (1998) notes that homicide is the leading cause of death among infants. Additionally, although infant deaths due to accidental causes such as fire fatalities and choking on objects has steadily declined, the rate for homicide continues to increase (Brenner et al, 1999). The violent assault or murder of one''s child, characterized by SBS can easily serve as a trigger for the child's loved ones to develop PTSD symptoms.
Just as the recognition of PTSD has grown, so have the treatment approaches to address it. Most effective treatments involve some form of reviewing the details of the traumatic event in an effort to help the individual integrate the traumatic memory. Traumatic memories are stored and retrieved in a very vivid, realistic fashion, unlike non-traumatic memories. A common goal of therapy is to transform those vivid re-experiences into a less overwhelming state that can be more easily dealt with by means of typical memory processing and affect regulation. One technique which can be helpful for processing traumatic memories is Eye Movement Desensitization and Reprocessing (EMDR). The treatment of psychological trauma has become an area of specialization and distinct focus in the mental health field. Treatment plans should be designed with the help of a trained specialist in the area.
It is important to realize that traumatic experiences can affect every aspect of a person's life. PTSD disrupts one's social, physiological, spiritual, emotional and interpersonal realms of functioning. For this reason a multi-faceted treatment approach is usually most effective. Such a program might include medication, psychotherapy and exercise. Although successful treatment for PTSD does not include forgetting the traumatic event, sufferers can learn how to live with the scar of their experience and regain productive and happy lives despite the tragedy.
Brenner RA, Overpeck MD, Trumble AC, DerSimonian R, Berendes H. Deaths attributable to injuries in infants, United States, 1983-1991. Pediatrics 1999;103:968-974.
Murphy SA, Braun T, Tillery L, Cain KC, Clark Johnson L, Beaton RD. PTSD among bereaved parents following the violent deaths of their 12-28 year old children: A longitudinal prospective analysis. J Traumatic Stress 1999;12:273-291.
Overpeck MD, Brenner RA, Trumble AC, Trifiletti LB, Berendes H. Risk factors for infant homicide in the United States. NEJM 1998;339:1211-1216.